Department of Radiation oncology (Duan Y,Li X,Yan CQ,Zhang J,Guo XD,Chen HR,Chen L,Zou Y),Central Laboratory (Lyu J),The General Hospital of the PLA Rocket Force Graduate Training Base,Jinzhou Medical University,Beijing 100088,China
Abstract： Objective To examine the effects of gross tumor volume (GTV) and radiation dose onthe prognosis of hepatocellular carcinoma (HCC) patients treated with whole body gamma knife. Methods The clinical data of 69 HCC patients who underwent body gamma knife treatment from January 2012 to June 2015 in the Radiotherapy Center of the PLA General Hospital were retrospectively reviewed. Based on a 50% or 60% isodose coverage of the planning target volume (PTV), patients were treated with a radiation dose of 4-5 Gy per fraction, and a total marginal dose of 36-50 Gy (median dose 45 Gy). Short-term efficacy, overall survival (OS), and the adverse effect of the treatment were evaluated. The optimal cut-off tumor volume was identified using the receiver operating characteristic curve, and survival was determined by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional hazards regression model, respectively. Results The overall short-term response rate of the 69 patients was 67%. The 1-and 2-year OS rates were 62% and 40%, respectively, with a median survival of 18.6 months. The multivariate analysis showed that gross tumor volume (GTV)<93 cm3(P=0.013) and short-term efficacy of radiotherapy (P=0.000) were significant independent prognostic factors for survival. When GTV was<93 cm3, prognosis was significantly better in patients treated with a dose of ≥45 Gy than in those with<45 Gy (P=0.019). In contrast, radiation dose had no significant effect on survival among patients with GTV>93cm3(P=0.665). Conclusions GTV is an independent prognostic factor for overall survival of HCC patients. Although high-dose radiotherapy provides survival benefits to patients with small GTV, it is not necessarily suitable for patients with large GTV.
. Effect of tumor volume and radiation dose on the prognosis of hepatocellular carcinoma patients treated with whole body gamma knife[J]. Chinese Journal of Radiation Oncology, 2017, 26(7): 763-767.
[1] Ferlay J,Soerjomataram I,Dikshit R,et al. Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J].Int J Cancer,2015,136(5):E359-386.DOI:10.1002/ijc.29210. [2] Siegel RL,Miller KD,Jemal A.Cancer statistics,2016[J].CA Cancer J Clin,2016,66(1):7-30.DOI:10.3322/caac.21332. [3] Brade AM,Ng S,Brierley J,et al. Phase 1 trial of sorafenib and stereotactic body radiation therapy for hepatocellular carcinoma[J].Int J Radiat Oncol Biol Phys,2016,94(3):580-587.DOI:10.1016/j.ijrobp.2015.11.048. [4] Klein J,Dawson LA.Hepatocellular carcinoma radiation therapy:review of evidence and future opportunities[J].Int J Radiat Oncol Biol Phys,2013,87(1):22-32.DOI:10.1016/j.ijrobp.2012.08.043. [5] Bruix J,Sherman M.Management of hepatocellular carcinoma:an update[J].Hepatology,2011,53(3):1020-1022.DOI:10.1002/hep.24199. [6] Eisenhauer EA,Therasse P,Bogaerts J,et al. New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.DOI:10.1016/j.ejca.2008.10.026. [7] Lawrence TS,Robertson JM,Anscher MS,et al. Hepatic toxicity resulting from cancer treatment[J].Int J Radiat Oncol Biol Phys,1995,31(5):1237-1248.DOI:10.1016/0360-3016(94)00418-K. [8] Que J,Kuo HT,Lin LC,et al. Clinical outcomes and prognostic factors of cyberknife stereotactic body radiation therapy for unresectable hepatocellular carcinoma[J].BMC Cancer,2016,16:451.DOI:10.1186/s12885-016-2512-x. [9] Yamashita H,Onishi H,Murakami N,et al. Survival outcomes after stereotactic body radiotherapy for 79 Japanese patients with hepatocellular carcinoma[J].J Radiat Res,2015,56(3):561-567.DOI:10.1093/jrr/rru130. [10] 吴盛荣,毛树权,黄凤鸣,等.γ刀治疗原发性肝癌 296例的临床研究[J].西南国防医药,2015,25(1):48-51.DOI:10.3969/j.issn.1004-0188.2015.01.018. Wu SR,Mao SQ,Huang FM,et al. Clinical research on treatment of PHC by gamma knife (a report of 296 cases)[J].Med J Nat Def For Southwest China,2015,25(1):48-51.DOI:10.3969/j.issn.1004-0188.2015.01.018. [11] 蔡君,李爽,梁赅,等.γ刀治疗 57例局部晚期原发性肝癌[J].肿瘤学杂志,2012,18(4):313-314. Cai J,Li S,Liang G,et al. Gamma knife in the treatment for 57 cases with locally advanced primary liver cancer[J].J Chin Oncol,2012,18(4):313-314. [12] Su TS,Liang P,Lu HZ,et al. Stereotactic body radiation therapy for small primary or recurrent hepatocellular carcinoma in 132 Chinese patients[J].J Surg Oncol,2016,113(2):181-187.DOI:10.1002/jso.24128. [13] Huang WY,Jen YM,Lee MS,et al. Stereotactic body radiation therapy in recurrent hepatocellular carcinoma[J].Int J Radiat Oncol Biol Phys,2012,84(2):355-361.DOI:10.1016/j.ijrobp.2011.11.058. [14] Lu XJ,Dong J,Ji LJ,et al. Tolerability and efficacy of gamma knife radiosurgery on hepatocellular carcinoma with portal vein tumor thrombosis[J].Oncotarget,2016,7(3):3614-3622.DOI:10.18632/oncotarget.6118. [15] Bae BK,Kim JC.The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy[J].Radiat Oncol J,2016,34(3):168-176.DOI:10.3857/roj.2016.01669. [16] Andratschke NH,Nieder C,Heppt F,et al. Stereotactic radiation therapy for liver metastases:factors affecting local control and survival[J].Radiat Oncol,2015,10:69.DOI:10.1186/s13014-015-0369-9. [17] 臧健,许曼,赵丽娜,等.鼻咽部肿瘤体积在中国西北非高发区鼻咽癌患者中的预后价值[J].西安交通大学学报(医学版),2017,38(1):117-121.DOI:10.7652/jdyxb201701025. Zang J,Xu M,zhao LM,et al. The prognostic value of primary tumor volume in non-endemic patients with nasopharynx carcinoma in northwest China[J].J Xi′an Jiaotong University (Med Sci),2017,38(1):117-121.DOI:10.7652/jdyxb201701025. [18] Zweig MH,Campbell G.Receiver-operating characteristic (ROC) plots:a fundamental evaluation tool in clinical medicine[J].Clin Chem,1993,39(4):561-577. [19] Im JH,Yoon SM,Park HC,et al. Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area[J].Liver Int,2016,DOI:10.1111/liv.13191. [20] Jang WI,Kim MS,Bae SH,et al. High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma[J].Radiat Oncol,2013,8:250.DOI:10.1186/1748-717X-8-250.
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